Living with dignity

'Often the test of courage is not to die but to live.' Count Vittorio Alfieri may have written these words over 200 years ago, but they ring just as true today in an Australia seemingly seduced by death.

In March, Senator Bob Brown introduced a private senator's bill into federal parliament to repeal the Euthanasia Laws Act 1997, thereby allowing territories to legalise euthanasia. Then, in April, the former Lord Mayor of Brisbane, Clem Jones, left a bequest of $5 million to fund a campaign for the legalisation of euthanasia.

These pieces of legislation, and the accompanying commentary, are often framed in terms of compassion and dignity. Opponents of euthanasia, or the oft-used palatable euphemisms such as mercy killing or death with dignity, are accused of being heartless and cruel.

Yet how many of us take the time to listen beyond media-friendly sound bites, and really engage with what may be one of the gravest, yet most subtly redefining issues of modern humanity? We fail the generations that follow if we shy away from the courageous examination of the issues at play in this current debate.

We must examine the notion of choice. Those in the pro-euthanasia movements often speak of euthanasia as a choice, and demand that every Australian be given the choice to end their life. However, there is an intrinsic flaw to this suggestion. To say that euthanasia is a choice denies the fact that the decision to end your life is rarely made apart from factors that place immense pressure on the individual.

For public debate to have integrity we must acknowledge that an often unspoken, yet powerful, influence in decisions relating to euthanasia is fear. Whether it is fear of pain, fear of losing physical or mental control, or fear of being a 'burden' to family, this fear is powerfully persuasive. And fear makes you vulnerable.

Ending your life is rarely, if ever, a decision made by those who are free from encumbrances. The decision to kill oneself is only ever made by those, or for those, who are vulnerable in some way — physically, mentally or emotionally.

While conversations about euthanasia are puzzlingly divorced from community dialogue on suicide, it is instructive for us to consider the broad issues that affect both subjects.

Author Edwin Schniedman, who studied suicide for nearly 50 years, said, 'Nearing the end of my career in suicidology, I think I can now say what has been on my mind in as few as five words: Suicide is caused by psychache.' Schniedman went on to describe psychache as the 'pain of excessively felt shame, or guilt, or humiliation, or loneliness, or fear, or angst, or dread of growing old, or of dying badly, or whatever'.

Fear, angst, dying badly — a psychological climate eerily similar to the one that affects those who would consider euthanasia. Such a climate makes incredulous the suggestion that a terminally ill person is capable of making a dispassionate choice, free from fear or pressure. The notion of choice is so clouded with uncertainty that it is almost powerless as a reason to support euthanasia.

Further, we must also engage with the idea behind euthanasia. We often treat euthanasia as simply a medical issue, and discuss issues including terminal disease, pain management, and palliative care. However, euthanasia, at its heart, is not primarily a medical question. Euthanasia is a values question.

Our social ethic no longer considers human life as having intrinsic value, but as something we can throw away at will. The idea behind euthanasia is that human life has no inherent, sacred value but is rather like a commodity to be used. Therefore, if we are to seriously engage with this issue, and protect the vulnerable, we must understand the cultural conditions that have allowed this to take root.

Within Judeo-Christian cultures, murder has always been considered wrong. This was because we considered life a gift from a creator God; hence it also was regarded as his alone to take. Civil governments were charged with keeping order, and passed laws that made the taking of a human life a criminal act. This was an absolute we all agreed on — the rules of play, if you like.

However, as we have embraced moral relativism and cast off any sense of responsibility to a higher power, such as a Judeo-Christian ethic brings, we have set ourselves up as the final arbiters of life — and of death.

The ramifications of such a change in worldview are crystallised in the words of Pieter Admiraal, a former Dutch anesthetist, who became one of Holland's leading campaigners for euthanasia. He said:

In 50 years time, you will see euthanasia accepted all over the world. It will be used with patients suffering from Alzheimer's who are otherwise kept alive for five or ten years. The time will come when we say that this costs money, and if you are demented for one year, we will kill you. I see it not as the answer to the growing elderly population but as the exercise of the right of self-determination.

In the philosophical world inhabited by the likes of Admiraal, the value of human beings is assessed against their 'quality of life' — a seemingly benign yet ultimately abhorrent phrase. This phrase, which is used as a replacement for 'sanctity of life', is oxygenated by this idea that life has no inherent value but is defined in terms of its usefulness.

This ethical leap, from life being a gift that we have a responsibility to protect, to life being a commodity to use at will, has staggering implications.

England's Baroness Mary Warnock, a medical ethics expert in Britain, expressed these implications in an interview with the London Sunday Times. Warnock explained that it is better for elderly people to kill themselves than to be a burden on their families and society. 'I don't see what is so horrible about the motive of not wanting to be an increasing nuisance,' she said.

Warnock's views are unusually confronting in their brutal honesty and assessment of the place of the vulnerable in our society. However, they are eminently logical if one follows the line of thought that euthanasia advocates lead us down. Surprise at Warnock's comments only comes from the fact that these views are expressed in raw terms of consequential action, rather than obscured by gentler sounding terms such as dignity and choice.

Finally, one of the deeply sobering, yet rarely examined, consequences of the euthanasia debate is the notion of dignity and its implications for those with disabilities.

The redefining of dignity, and the concept that some of the processes of dying are inherently undignified, has, in effect, passed judgement, not upon the death of some, but upon the life of many. The value judgements behind 'dying with dignity' are actually highly offensive to those with physical or mental disabilities, and who have to live each day with the symptoms that euthanasia advocates deem 'undignified'.

In a ruling against a request for someone to be allowed to 'die with dignity' the Alaskan Supreme Court explained this concept:

Unlike the concept of pain, the concepts of 'dignity' and 'degradation' are expressions of prevailing social norms. As Professor Peter Hammer has said, '... dignity is inherently a relational concept, defining the person with respect to her community'.

Thus, feelings of indignity or degradation are not caused directly by terminal illness. Rather, they are caused by the community's reactions to the disabilities that accompany terminal illness or by the patient's expectation of adverse community reaction.

In Professor Hammer's words, '...feelings of indignity are largely fears of rejection by our community'. Two of the most important fears of rejection that accompany the dying process are the fear of violating social norms related to incontinence and the fear of violating social norms related to dependence on others.

Men and women around Australian have to live every day with physical limitations such as incontinence and dependence on others. When the pro-euthanasia movement advocates death as a far better option than living in such a state, they make horrific comment about the status of people with disabilities. Such a stance is not only highly offensive, but is cruel and lacking in compassion.

The late Dutch euthanasia opponent, Dr. Karl Gunning said, 'Once killing is seen as the answer to one problem, it soon becomes the answer to 100'. Therefore, we cannot afford to abandon even one person to the false notions of choice, to the commodification of human life and to the redefinition of dignity that euthanasia embodies.

Medical funding and training for effective pain management and palliative care is essential if society wishes to offer a comprehensive and compassionate response to suffering. However, Australia also needs courageous voices that advocate, truly, for the terminally ill. Often the test of courage is not to stay silent but to speak out.

Ruth Limkin is the pastor of Northside Christian Church, a large contemporary Christian church in Brisbane. She is a freelance journalist who writes occasionally for the Brisbane Courier Mail. This essay was the winner of the 2008 Margaret Dooley Award for Young Writers.

Recent articles by Ruth Limkin.

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I helped my brother to die years ago. It was what he wanted; his liver function was approaching zero and he was dragging himself to the toilet vainly every few minutes. In the event his death by prescription drug was a profound experience for me and others around him who were helping and who this way were given a chance to say goodbye.

If others are prepared to see their loved ones perish miserably against their expressed wishes on the basis of words written in an obscure book, let them live with the knowledge that they could have helped in ameliorating hopeless pain and misery. This is currently their own concern; the question is whether they have a moral right to inflict profound cruelty on others by exercising legal compulsion and by grossly distorting reality in their arguments.Gerry Harant | 13 August 2008

A wonderful article. I work with people who have acquired a brain injury (mostly through car accidents). These people could be viewed by some as no longer productive and/or a financial strain and thus candidates for euthanasia. However their human stories of survival and hope inspire great admiration and compassion within me and many others.

It is a journey that the majority do not regret making. They are all prophets of human vulnerability and invite us to walk this world more in hope and love than fear.

Let us not forget that the Christian God works best through those of us who believe we have nothing left to lose. The people i work with show me what i have lost and what i could lose: those attitudes and beliefs that get in the way of love having its way with me. I am continually humbled by them and gently 'put in my place'. Andrew McAlister | 13 August 2008

I expect to kill myself in the foreseeable future (I am now 80), just because my life is accomplished and coming to an end. I am normal, sane, not depressed (not religious), at ease with myself and my friends and relations. This piece shows no comprehension of this notion of the end of life, held by thousands of us out here. Ms Limkin's talk of fear and ethics is not relevant to us.Peter Shaw | 13 August 2008

Joan Hume in The Disabled Adult wrote in 1992: 'Handicapism is alive and well and living in Australia ... we (the handicapped)represent a threat to the social order ... we frighten and confront ... We continually remind others that we do not live in a perfect world and ... that people don't necessarily live happily ever after.'

Ruth Limkin understands this in 2008 and has the courage to uphold the value of the sacredness of human life, a principle that is not yet politically acceptable in our country. Well done Ruth.Claude Rigney | 13 August 2008

Very moving, and well argued. This essay brings into fresh perspective some well-worn aspects of the euthanasia debate. Congratulations to Ruth Limkin for presenting the issues so well.Denis Fitzgerald | 14 August 2008

Where is the evidence for "Our social ethic no longer considers human life as having intrinsic value, but as something we can throw away at will." We spend a large amount of the health budget on people at the end of their lives - to prolong their lives as long as possible: evidence that we value life very highly. We abolished capital punishment etc etc.

"The value judgements behind 'dying with dignity' are actually highly offensive to those with physical or mental disabilities" is actually highly offensive to people who wish to end their own lives, because I've never heard those people suggest that anyone else, in any condition, should end theirs. They wish to make a personal decision about themselves, there is no implication that other people should take any "message" about that at all.Russell | 15 August 2008

I am uneasy about the reification of "life" as though it was some kind of physical entity, given to us by God. I understand that everything I have is given by God, including "life", if that is a thing among other things. I wonder if, without this "life", I would still be me. Presumably I would, in a rather ambiguous way.

I am also puzzled to know how the decision to end one's mortal condition can possibly be made "discompassionately".Br William SSF | 18 August 2008

Thank you Ruth.
Wonderful to read such a thoughtful, deep and so eminently compassionate article that deals with life as it is lived with all its challenges. As i walk the road with a mother dying I have never felt a greater recognition of the sacredness of life. A relation in New Zealand said to me years ago, only a month or so from her own death, said" we are left to live as long as we have something to learn or something to teach".David Dignam | 21 August 2008

Gerry Harant & Peter Shaw, succinctly and wonderfully written. I agree completely! I have been watching my 67yo aunt die a slow and horrendous death from cancer for 3 years now. You wouldn't let an animal suffer like this, so why hasn't she the right to end her life with dignity surrounded by her family at her bed in a manner she sees fit. Perhaps this country will eventually move out of the dark ages and spare future generations the same cruel fate.Catherine (38) | 04 September 2009

Ruth,
Murder is actually demanded in the Bible - ie, parents must kill children who talk back. Can't remember the reference, but it is there, along with countless other orders by God to kill.Bob Meadows | 11 June 2010

If religous belief prohbits asking a doctor to end one's life, then everyone is free to have that belief respected.

The Catholic or any other church has no right to have the state enforce religous beliefs on people who do not share them. A significiant majority of people of faith, including Roman Catholics, support legalising VE.

Nurses in Catholic hospitals are ashamed of the ideological insistance on other people's suffering that the hierarchy is content to impose.

It took Christ only 6 hours to die on the Cross. It normally took 2-3 days, and His legs and arms were not broken, as was often done to hasten death. Was He assisted?

Christ said He did not have to go to Calvary. So He gave up His life on Earth - suicide.Mark Lawrence | 24 November 2010

Thank you for this writing.Audrey Laferriere | 26 April 2011

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